PREFERRED GENERIC DRUG LIST

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1 These discount programs are NOT health insurance policies and are not intended as a substitute for insurance. The programs do not qualify as a minimum creditable coverage under Massachusetts law or where prohibited by law. The programs only provide for discounts on health services from participating pharmacies, and the range of the discounts will vary depending on the health services received. The programs do not make payments to pharmacies of health care services. Members are required to pay for all health care services, but will receive a discount from the contracted pharmacies. Except in the states of California, Utah, and Washington, these are custom-branded programs, provided and administered by Medical Security Card Company, LLC, (MSC), 4911 E. Broadway Boulevard, Tucson, AZ 85711, , and marketed by Kmart. These programs are not available in all states and the terms of each program may vary from state to state. Each program is governed by the applicable terms of the membership agreement provided upon activation and made available at MSC is not responsible for providing or guaranteeing pharmacy services or for the quality of such rendered services. Participating pharmacies are subject to change without notice and are not available in all areas. The program contracts are not protected by any state guaranty fund. 2 An annual fee of $10 is payable at the time of initial enrollment and enrollment renewal. The program, as well as the prices and the list of covered drugs, can be modified at any time without notice. 2 Notwithstanding the above, the programs, as described above and available in the states of California, Utah, and Washington, are custom-branded and operated directly by Kmart. The applicable terms relating to any such Kmart custom-branded and operated program shall also be available at www. KmartPrescriptionSavingsClub.com. MSC may participate or assist in the administration of such programs. For questions, please call , log on to or see the pharmacist for further details. REVISED MAY 1, 2015 Preferred generic drugs supply* for $5 or $10 supply* for $10, $15, $20 or $30 *The day supply is based upon the average dispensing patterns for the specific drug and strength. supply price starts at $5. supply price starts at $10. a Select drugs for a 30-Day Supply are priced at $10; b Select drugs for a 90-Day Supply are priced at $15; c Select drugs for a 90-Day Supply are priced at $20; d Select drugs for a 90-Day Supply are priced at $30. ALLERGIES & COLD AND FLU BENZONATATE 100 MG CAP CETIRIZINE HCL 5 MG TAB CETIRIZINE HCL 10 MG TAB CHLORPHENIRAMINE MALEATE 4 MG TAB CLEMASTINE FUMARATE 1.34 MG TAB b DIPHENHYDRAMINE HCL 50 MG CAP b D-METHORPHAN HB/PROMETH HCL /5 SYRUP Select Women s and Men s Health prescription medications are available in up to a 30- day supply for $12.00 each or in up to a supply for $36.00 each (see last page). 1

2 GUAIFENESIN/DEXTROMETHORPHAN MG/5 LIQUID b LORATADINE 10 MG TAB PROMETHAZINE HCL 25 MG TAB PROMETHAZINE HCL 50 MG TAB b PROMETHAZINE HCL 6.25MG/5ML SYRUP b ANTIBIOTIC & ANTI-INFECTIVE TREATMENTS ACYCLOVIR 200 MG CAP b AMOXICILLIN 250 MG CAP b AMOXICILLIN 500 MG CAP AMOXICILLIN 125 MG/5ML SUSP b AMOXICILLIN 200 MG/5ML SUSP b AMOXICILLIN 250 MG/5ML SUSP b AMOXICILLIN 400 MG/5ML SUSP AMOXICILLIN 125 MG TAB b AMPICILLIN TRIHYDRATE 250 MG CAP b AMPICILLIN TRIHYDRATE 500 MG CAP b BACITRACIN ZINC 500 UNIT/G OINT b BACITRACIN ZINC 500 UNIT/G PACKET b CEPHALEXIN 250 MG CAP b CEPHALEXIN 500 MG CAP b CIPROFLOXACIN HCL 250 MG TAB b CIPROFLOXACIN HCL 500 MG TAB b ISONIAZID 300 MG TAB 30 a 90 c PENICILLIN V POTASSIUM 250 MG TAB b PENICILLIN V POTASSIUM 250 MG/5ML SOLN b SMZ/TMP 400MG-80MG TAB b SMZ/TMP MG TAB b ARTHRITIS & PAIN ASPIRIN 81 MG TAB b CYCLOBENZAPRINE HCL 5 MG TAB CYCLOBENZAPRINE HCL 10 MG TAB DIBUCAINE 1 % OINT b IBUPROFEN 400 MG TAB b IBUPROFEN 600 MG TAB b IBUPROFEN 800 MG TAB b MELOXICAM 7.5 MG TAB MELOXICAM 15 MG TAB NAPROXEN 250 MG TAB b NAPROXEN 375 MG TAB b NAPROXEN 500 MG TAB b NAPROXEN 375 MG TAB EC b NAPROXEN SODIUM 275 MG TAB b 2 2

3 ASTHMA ALBUTEROL SULFATE 2 MG/5 ML SYRUP b ALBUTEROL SULFATE 2.5 MG/3ML VIAL-NEB b IPRATROPIUM BROMIDE 0.2 MG/ML SOLN b DIABETES GLIMEPIRIDE 1 MG TAB GLIMEPIRIDE 2 MG TAB GLIMEPIRIDE 4 MG TAB GLIPIZIDE 5 MG TAB GLIPIZIDE 10 MG TAB GLYBURIDE 1.25 MG TAB b GLYBURIDE 2.5 MG TAB 30 a 90 c GLYBURIDE 5 MG TAB 30 a 90 c GLYBURIDE, MICRONIZED 1.5 MG TAB GLYBURIDE, MICRONIZED 3 MG TAB GLYBURIDE,MICRONIZED 6 MG TAB GLYBURIDE/METFORMIN HCL MG TAB 60 a 180 d GLYBURIDE/METFORMIN HCL MG TAB 60 a 180 d GLYBURIDE/METFORMIN HCL 5 MG-500MG TAB 90 a 270 d METFORMIN HCL 500 MG TAB METFORMIN HCL 750 MG TAB 60 a 180 d METFORMIN HCL 850 MG TAB METFORMIN HCL 1000 MG TAB METFORMIN HCL ER 500 MG TAB b FUNGAL INFECTIONS FLUCONAZOLE 150 MG TAB 1 3 b TERBINAFINE HCL 250 MG TAB 30 a 90 d GASTROINTESTINAL HEALTH CIMETIDINE 300 MG TAB 30 a 90 d CIMETIDINE 400 MG TAB 30 a 90 d DICYCLOMINE HCL 10 MG CAP b DICYCLOMINE HCL 20 MG TAB b DOCUSATE CALCIUM 240 MG CAP DOCUSATE SODIUM 100 MG CAP b FAMOTIDINE 20 MG TAB b FAMOTIDINE 40 MG TAB 30 a 90 c LACTULOSE 10 G/15 ML SOLN b LACTULOSE 20 G/30 ML SOLN b LACTULOSE 10 GM/15 ML SYRUP b METOCLOPRAMIDE HCL 5 MG/5 ML SOLN METOCLOPRAMIDE HCL 10 MG/10ML SOLN METOCLOPRAMIDE HCL 10 MG TAB

4 OMEPRAZOLE 20 MG CAP 30 a 90 d PROCHLORPERAZINE MALEATE 5 MG TAB b PROCHLORPERAZINE MALEATE 10 MG TAB RANITIDINE HCL 15 MG/ML SYRUP b RANITIDINE HCL 150 MG TAB RANITIDINE HCL 300 MG TAB GLAUCOMA & EYE CARE FLURBIPROFEN SODIUM 0.03 % DROPS 2 6 b FLUTICASONE PROPIONATE 50 MCG SUSP 16 a 48 c NAPHAZOLINE HCL 0.1 % DROPS b TIMOLOL MALEATE 0.25 % DROPS 5 15 TIMOLOL MALEATE 0.5 % DROPS 5 15 b HEART HEALTH & BLOOD PRESSURE AMLODIPINE BESYLATE 2.5 MG TAB AMLODIPINE BESYLATE 5 MG TAB AMLODIPINE BESYLATE 10 MG TAB 30 a 90 c ATENOLOL 25 MG TAB ATENOLOL 50 MG TAB ATENOLOL 100 MG TAB BENAZEPRIL HCL 5 MG TAB b BENAZEPRIL HCL 10 MG TAB b BENAZEPRIL HCL 20 MG TAB b BENAZEPRIL HCL 40 MG TAB b BISOPROLOL FUMARATE/HCTZ MG TAB b BISOPROLOL FUMARATE/HCTZ MG TAB b BISOPROLOL FUMARATE/HCTZ MG TAB b CARVEDILOL MG TAB CARVEDILOL 6.25 MG TAB CARVEDILOL 12.5 MG TAB CARVEDILOL 25 MG TAB b CLONIDINE HCL 0.1 MG TAB CLONIDINE HCL 0.2 MG TAB DILTIAZEM HCL 30 MG TAB DILTIAZEM HCL 60 MG TAB 60 a 180 c DILTIAZEM HCL 90 MG TAB 60 a 180 c DILTIAZEM HCL 120 MG TAB 30 a 90 c ENALAPRIL MALEATE 5 MG TAB b ENALAPRIL-HCTZ MG TAB b FOSINOPRIL SODIUM 20 MG TAB 30 a 90 d FOSINOPRIL SODIUM 40 MG TAB 30 a 90 d FUROSEMIDE 20 MG TAB FUROSEMIDE 40 MG TAB

5 FUROSEMIDE 80 MG TAB GEMFIBROZIL 600 MG TAB 60 a 180 d GUANFACINE HCL 1 MG TAB GUANFACINE HCL 2 MG TAB b HYDRALAZINE HCL 25 MG TAB b HYDROCHLOROTHIAZIDE 12.5 MG CAP HYDROCHLOROTHIAZIDE 25 MG TAB HYDROCHLOROTHIAZIDE 50 MG TAB INDAPAMIDE 1.25 MG TAB INDAPAMIDE 2.5 MG TAB LISINOPRIL 2.5 MG TAB LISINOPRIL 5 MG TAB LISINOPRIL 10 MG TAB LISINOPRIL 20 MG TAB LISINOPRIL 30 MG TAB LISINOPRIL 40 MG TAB 30 a 90 c LISINOPRIL-HCTZ MG TAB LISINOPRIL-HCTZ MG TAB LISINOPRIL-HCTZ MG TAB 30 a 90 c LOSARTAN POTASSIUM 50 MG TAB 30 a 90 d LOVASTATIN 10 MG TAB LOVASTATIN 20 MG TAB LOVASTATIN 40 MG TAB METOPROLOL TARTRATE 25 MG TAB METOPROLOL TARTRATE 50 MG TAB METOPROLOL TARTRATE 100 MG TAB b PRAZOSIN HCL 1 MG CAP 30 a 90 c PROPRANOLOL HCL 10 MG TAB PROPRANOLOL HCL 20 MG TAB 60 a 180 c PROPRANOLOL HCL 40 MG TAB QUINAPRIL HCL 5 MG TAB 30 a 90 d SIMVASTATIN 10 MG TAB SIMVASTATIN 20 MG TAB 30 a 90 c SIMVASTATIN 40 MG TAB 30 a 90 c SIMVASTATIN 80 MG TAB SOTALOL HCL 80 MG TAB 30 a 90 d SPIRONOLACTONE 25 MG TAB TERAZOSIN HCL 1 MG CAP TERAZOSIN HCL 2 MG CAP TERAZOSIN HCL 5 MG CAP TERAZOSIN HCL 10 MG CAP TORSEMIDE 10 MG TAB b 5 5

6 TRIAMTERENE-HCTZ MG TB 30 a 90 c VERAPAMIL HCL 80 MG TAB VERAPAMIL HCL 120 MG TAB VERAPAMIL HCL 180 MG TAB 30 a 90 c WARFARIN SODIUM 1 MG TAB 30 a 90 c WARFARIN SODIUM 2 MG TAB 30 a 90 c WARFARIN SODIUM 2.5 MG TAB 30 a 90 c WARFARIN SODIUM 3 MG TAB 30 a 90 c WARFARIN SODIUM 4 MG TAB 30 a 90 c WARFARIN SODIUM 5 MG TAB 30 a 90 c WARFARIN SODIUM 6 MG TAB 30 a 90 c WARFARIN SODIUM 7.5 MG TAB 30 a 90 c WARFARIN SODIUM 10 MG TAB 30 a 90 c MENTAL & NEURO HEALTH AMITRIPTYLINE HCL 10 MG TAB b AMITRIPTYLINE HCL 25 MG TAB b AMITRIPTYLINE HCL 50 MG TAB 30 a 90 d AMITRIPTYLINE HCL 75 MG TAB 30 a 90 d BUSPIRONE HCL 5 MG TAB BUSPIRONE HCL 10 MG TAB b CITALOPRAM HBR 20 MG TAB CITALOPRAM HBR 40 MG TAB DOXEPIN HCL 10 MG CAP 30 a 90 d FLUOXETINE HCL 20 MG CAP FLUOXETINE HCL 40 MG CAP 30 a 90 c FLUPHENAZINE HCL 1 MG TAB FLUPHENAZINE HCL 2.5 MG TAB GABAPENTIN 100 MG CAP 90 a 270 c GABAPENTIN 400 MG CAP 90 a 270 d HALOPERIDOL 0.5 MG TAB HALOPERIDOL 1 MG TAB 30 a 90 c HALOPERIDOL 2 MG TAB b LITHIUM CARBONATE 150 MG CAP b LITHIUM CARBONATE 300 MG CAP b NORTRIPTYLINE HCL 10 MG CAP NORTRIPTYLINE HCL 25 MG CAP b PAROXETINE HCL 10 MG TAB b PAROXETINE HCL 20 MG TAB b PRAMIPEXOLE DI-HCL 0.5 MG TAB 30 a 90 d SERTRALINE HCL 25 MG TAB b SERTRALINE HCL 50 MG TAB b SERTRALINE HCL 100 MG TAB b 6 6

7 TRAZODONE HCL 50 MG TAB TRAZODONE HCL 100 MG TAB TRAZODONE HCL 150 MG TAB b ZONISAMIDE 25 MG CAP 30 a 90 d OTHER MEDICAL CONDITIONS ALLOPURINOL 100 MG TAB b ALLOPURINOL 300 MG TAB 30 a 90 d CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH DEXAMETHASONE 0.5 MG TAB b DEXAMETHASONE 0.75 MG TAB b DEXAMETHASONE 4 MG TAB 6 18 b LIDOCAINE HCL 2% SOLN b PHENAZOPYRIDINE HCL 100 MG TAB 6 18 b PREDNISOLONE 15 MG/5 ML SOLN b PREDNISONE 2.5 MG TAB SKIN CONDITIONS HYDROCORTISONE 1 % CRM b HYDROCORTISONE 1 % PACKET b HYDROCORTISONE 2.5 % CRM b HYDROCORTISONE 2.5 % OINT b HYDROCORTISONE/ALOE VERA 1 % CRM b THYROID CONDITIONS LEVOTHYROXINE 25 MCG TAB 30 a 90 d LEVOTHYROXINE 50 MCG TAB 30 a 90 d LEVOTHYROXINE 75 MCG TAB 30 a 90 d LEVOTHYROXINE 88 MCG TAB 30 a 90 d LEVOTHYROXINE 100 MCG TAB 30 a 90 d LEVOTHYROXINE 112 MCG TAB 30 a 90 d LEVOTHYROXINE 125 MCG TAB 30 a 90 d LEVOTHYROXINE 150 MCG TAB 30 a 90 d METHIMAZOLE 5 MG TAB VITAMINS & NUTRITIONAL HEALTH BETA-CAROTENE(A) W-C & E/MIN CAP b BETA-CAROTENE(A) W-C & E/SE CAP b CALCIUM CARBONATE/VITAMIN D3 600 MG-200 TAB b CITRIC ACID/SODIUM CITRATE MG SOLN CO-NATAL FA TAB b ERGOCALCIFEROL (VITAMIN D2) UNIT CAP 4 12 FOLIC ACID 1 MG TAB FOLIC ACID/VITAMIN B COMP W-C 1 MG-100MG TAB b MAGNESIUM CHLORIDE 64 MG TAB b MAGNESIUM OXIDE 400 MG TAB b 7 7

8 MULTIVIT/FOLIC ACID/ZINC/VIT C CAP b MULTIVITAMIN WITH MINERALS CAP b MULTIVITAMINS WITH MIN NO.7/FA 1 MG CAP b MULTIVITAMINS,THER W-MINERALS CAP b MEDROXYPROGESTERONE 2.5 MG TAB MEDROXYPROGESTERONE 5 MG TAB MEDROXYPROGESTERONE 10 MG TAB MEGESTROL ACETATE 20 MG TAB b MULTIVITS-MINERALS/FA/LYCOPENE 0.4MG-600 CAP b POTASSIUM CITRATE/CITRIC ACID /5 SOLN b PRENATABS RX TAB 30 a 90 d PRENATAL PLUS TAB 30 a 90 d SOD/POT/K CIT/SOD CIT/CIT ACID /5 SOLN b SODIUM FLUORIDE 0.25 (0.55) TAB b SODIUM FLUORIDE 0.5 (1.1)MG TAB b SODIUM FLUORIDE 1MG (2.2MG) TAB b VIT B CMPLX 3/FA/VIT C/BIOTIN 1MG-60MG TAB b VIT B COMPLEX & C NO.19/FA/D TAB b VIT C/VIT E AC/LUT/MINERAL CAP b VITAMIN A/VIT C/VIT E/SELENIUM CAP b WOMEN S HEALTH ALENDRONATE SODIUM 5 MG TAB b ESTRADIOL 0.5 MG TAB Select Women s and Men s Health prescription medications are available in up to a supply* for $12.00 each or up to a supply* for $36.00 each. WOMEN S HEALTH Supply Supply ALENDRONATE SODIUM 10 MG TAB ALENDRONATE SODIUM 35 MG TAB 4 12 ALENDRONATE SODIUM 70 MG TAB 4 12 DESOGESTREL-ETHINYL ESTRADIOL TAB LEVONORGESTREL-ETHIN ESTRADIOL TAB TAMOXIFEN CITRATE 10 MG TAB MEN S HEALTH Supply Supply FINASTERIDE 5 MG TAB A0158_KMART_CLASS_DL_ ESTRADIOL 1 MG TAB 30 a 90 c ESTRADIOL 2 MG TAB

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